WELCOME. Million Hearts for Millions of Meals: Reducing Sodium in Home Delivered and Congregate Meals. The webinar will begin at 3:00 p.m.

Transcription

1 WELCOME to Million Hearts for Millions of Meals: Reducing Sodium in Home Delivered and Congregate Meals The webinar will begin at 3:00 p.m. Eastern Presenters: Jessica Levings, Maria Mahar, Barbara Estrada and Deanne Brandstetter Facilitators: Linda Netterville and Magda Hageman-Apol

2 Webinar Tips Your phone will muted during the webinar Please feel free to ask your questions throughout the webinar by using the Questions box

3 Type your questions and comments here

4 Agenda Holly Greuling, RD, LD/N, Nutritionist, Office of Nutrition and Health Promotion Programs AoA/ACL, U.S. Department of Health and Human Services Jessica Levings MS RD, Federal Contractor/Policy Analyst at Centers for Disease Control and Prevention Maria C Mahar MA RD CDN, Project Director & Senior Nutritionist at Onondaga County Department of Adult & Long Term Care Services Barbara Estrada MS RD, Public Health Nutrition Consultant at the California Department of Aging Deanne Brandstetter MBA RD CDN, Vice President, Nutrition and Wellness at the Compass Group North America

5 Million Hearts for Millions of Meals: Reducing Sodium in Home Delivered and Congregate Meals Jessica Levings, MS, RD Federal Contractor/Policy Analyst Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention March 13, 2014 National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention

6 Sodium Reduction: A Public Health Imperative Excess sodium intake leads to hypertension Nearly 1 in 3 U.S. adults has hypertension (68 million people) Middle-aged and older men and women have a 90% lifetime risk of developing hypertension More than 1 in 2 people with hypertension do not have it under control In observational studies, the rise in blood pressure in response to higher sodium intake increases with age and older adults have been found to be more responsive to changes in sodium intake Vital Signs: MMWR 2011; 60(4):1-3 8 Vasan, et al. JAMA 2002;287:

7 Dietary Guidelines for Americans Sodium Intake Recommendation 1,500 mg sodium per day for individuals age 70 and older

8 44% of U.S. Sodium Intake, 10 Types of Food Rank Food Types % 1 Bread and rolls Cold cuts and cured meats Pizza Poultry Soups Sandwiches Cheese Pasta mixed dishes Meat mixed dishes Savory snacks 3.1 Source: CDC. MMWR. 2012;61:92 8.

9 Sodium Levels for the Same Food Can Vary Widely Source: CDC. Vital Signs: Where s the Sodium?

10 Sodium Content in Home Delivered and Congregate Meals Average intake of sodium over 24 hours in the congregate and home-delivered meal setting was 2,568 mg and 2,352 mg per day, respectively About 80% of title lll meals had more than 1,000 mg sodium per day Only 4% and 12% of meals offered in the congregate and home delivered meals program, respectively, contained less than 800 mg per day 43% of congregate meal program participants reported the meal program was a major source of their food, and 56% reported it was one of several food sources

11 Million Hearts Goal: Prevent 1 million heart attacks and strokes by 2017 US Department of Health and Human Services initiative, co-led by: Centers for Disease Control and Prevention (CDC) Centers for Medicare & Medicaid Services (CMS) Partners across federal and state agencies and private organizations 11

12 Key Components of Million Hearts Keeping Us Healthy and Addressing Health Disparities Changing the environment Excelling in the ABCS Optimizing care Focus on the ABCS Health tools and technology TRANS FAT Innovations in care delivery Glantz. Prev Med. 2008; 47(4): How Tobacco Smoke Causes Disease: A Report of the Surgeon General,2010.

13 Targets for the Environment Intervention Pre-Initiative Estimate 2017 Populationwide Goal Smoking prevalence 21% 19% Sodium reduction ~ 3.5 g/day 20% reduction Trans fat reduction ~ 1% of calories 50% reduction Sources: National Health Interview Survey, National Health and Nutrition Examination Survey

14 IOM Strategies to Reduce Sodium Intake excess sodium intake is strongly associated with elevated blood pressure, a serious public health concern related to increased risk of heart disease, stroke, congestive heart failure, and renal disease. The current level of sodium added to the food supply by food manufacturers, foodservice operators, and restaurants is simply too high to be safe for consumers.

15 CDC s Sodium Reduction Initiative Building the evidence base around effective strategies to reduce sodium consumption Providing funding to communities to understand what works Providing assistance to the public health community Collaborating with stakeholders, including the food industry Building momentum in public-private sector partnerships to reduce sodium in the food supply Educating the public

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17 Resources Tips for reducing sodium intake in older adults, Savor the Flavor with Less Sodium Provider resources for reducing sodium, Online Resources: Reducing Sodium in Congregate and Home Delivered Meals

18 Additional Resources

19 Thank You For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention

20 Sodium is the New Trans Fat Maria Mahar MA RD CDN Director of Nutrition Services Onondaga County Department of Adult and Long Term Care Services Syracuse, New York 20

21 Million Hearts for Millions of Meals New York State Unit on Aging Policy 90-PI-26 Revised Nutrition Program Standards Section IV. Menu/Nutrient Requirements 21

22 Million Hearts for Millions of Meals A. Menu Planning The Area Agency on Aging shall ensure that: 1. Participants comments on meals are routinely solicited and are considered when planning menus 2. Menus are planned based on recommendations contained in the current dietary guidelines 3. Menu items are evaluated to ensure their suitability to program operations. B. Nutrient Content The Area Agency on Aging shall ensure that: 1. Menus are certified by a registered dietitian to ensure that the meals provide one third or two thirds of the recommended dietary allowance for a male 51 years and older. 22

23 Million Hearts for Millions of Meals Our county uses the ESHA Food Processor to conduct the nutrient analysis to make sure Dietary Reference Intake (DRI) guidelines are being met. However... 23

24 Million Hearts for Millions of Meals Customer Satisfaction Surveys Menus that meet religious requirements or ethnic backgrounds. 24

25 Million Hearts for Millions of Meals 25

26 Million Hearts for Millions of Meals Prepared/Processed vs. Fresh Cooked Foods RD/DTRs noted that the sodium content of menu items are higher than the menu items that have been manually added in the ESHA database. There was a 50% reduction in the sodium content of the menus when the agency standardized recipes were used 26

27 Million Hearts for Millions of Meals If a menu item is high in sodium, we will recommend that the rest of the menu items for the day are fresh cooked food items vs. processed food. For example: fresh fruit for dessert or made of fresh fruit 27

28 Million Hearts for Millions of Meals Communicate with you State Unit on Aging Guidance and ideas on what other counties are doing Work with agency providers on menu development Focus on one menu at a time Working Together is Success Henry Ford 28

29 Million Hearts for Millions of Meals And Let s Not Forget.... Our Seniors Nutrition Education - Educating our seniors on the new regulations and the reasons for menu changes. 29

30 Million Hearts for Millions of Meals More Questions?? Contact information Maria C. Mahar MA RD CDN x

31 DEVELOPING DIETARY GUIDANCE FOR OLDER AMERICANS ACT NUTRITION SERVICES B A R B A R A E S T R A D A M S R D N U T R I T I O N C O N S U L T A N T C A L I F O R N I A D E P A R T M E N T O F A G I N G

32 DIETARY GUIDELINES FOR AMERICANS Good Nutrition decreases risk of chronic disease and saves health care dollars. The Dietary Guidelines for Americans (DGA) establish the scientific and policy basis for all federal nutrition food assistance programs. Provide information for making food choices that promote health and prevent disease. PolicyDocument.htm

33 ACTION STEPS FOR ALL AMERICANS Balance calories with physical activity to manage weight Consume more of certain foods and nutrients such as fruits, vegetables, whole grains, fat-free and lowfat dairy products, and seafood Consume fewer foods with sodium, saturated fats, trans fats, cholesterol, added sugars, and refined grains

34 THE DIETARY REFERENCE INTAKES

35 WHAT ARE THE HEALTH ISSUES OF OLDER ADULTS IN YOUR STATE? Leading causes of Death in California Heart Disease Cancer Stroke The California Department of Aging incorporates the key nutrient recommendations from the DGAs and DRIs that impact older Californians health status into ENP menu planning guidance. Use the AGID database!

36 SODIUM Dietary Guidelines for Americans Recommends: Those who are 51 and older, African American or have hypertension, diabetes, or chronic kidney disease reduce their sodium intake to 1500 milligrams per day. CDA recommended a liberalized sodium content for meals based on the information from the 2009 National Survey of OAA participants, the data indicated that the ENP meal provides percent of the participant s daily intake for more than half of the participants. (AGID database survey questions)

37 REDUCING SODIUM IN THE MENU PLAN Menu planners should take steps to reduce the levels of sodium in meals over time: Focus on a stepwise reduction of sodium over time Set a goal to reduce sodium content of meals each year. Example goal: The local OAA Nutrition Program will reduce the sodium level of the meals by 5 percent over the fiscal year or Example goal: The local OAA Nutrition Program will provide not more than two high sodium meals per month Document the decrease of sodium content of meals over time

38 REDUCING SODIUM IN THE MENU PLAN Target mg per meal Reduce levels of sodium in meals over time. Place potassium rich foods on the menu Provide nutrition education on the health impact of sodium intake on older adults Place an icon denoting a high sodium meal on the menu

39 OTHER MENU PLANNING CONSIDERATIONS Prepare foods without adding salt in the cooking process Take salt out of the kitchen and place it on the tables Use herbal seasoning to replace salt Encourage using oil and vinegar as the preferred salad dressing Provide at least one low-sodium salad dressing option Establish policies and procedures for purchasing healthful foods that incorporate the DGA s sodium recommendations ENP s can participate in transforming the food service industry by creating a demand for products that are lower in sodium and working with food purveyors to purchase lower sodium foods.

40 GOALS FOR THE OAA NUTRITION PROGRAMS Maintain the health and reduce the risk of chronic disease of older adult participants Complete good nutrition analysis including sodium levels Increase the demand for low-sodium products

41 QUESTIONS?

42 TASTING SUCCESS WITH CUTTING SALT Deanne Brandstetter, MBA, RDN, CDN Vice President, Nutrition & Wellness Compass Group

43 Why sodium? Why now? NYC Health Department Announces Proposed Targets for Voluntary Salt Reduction in Packaged and Restaurant Foods Institute of Medicine releases Strategies to Reduce Sodium Intake in the United States Report 2010 Dietary Guidelines Advisory Committee Report is released recommending reducing the upper limit for sodium intake from 2,300 to 1,500 mg/day recommendations expected to be 1500 mg. January 2010 April 2010 June 2010

44 The current level of sodium added to the food supply by food manufacturers, foodservice operators, and restaurants is simply too high to be safe for consumers given the chronic disease risks associated with sodium intake for all population segments. Institute of Medicine of the National Academies of Science Strategies to Reduce Sodium Intake in the United States Report Available at

45 Recommended Upper Limits Based on the 2005 Dietary Guidelines for Americans General Population High Risk Individuals* Percent of U.S. Population 31% 69% Sodium 2,300 mg 1,500 mg High Risk Individuals include: African Americans (>12% of U.S. population) 2010 Dietary Guidelines Advisory Anyone over age 50 (>30% of U.S. population) Committee Report recommends 1,500 mg for entire population Anyone with high blood pressure (>32% of adult U.S. population) Anyone with diabetes (>8% of entire U.S. population)

46 What do consumers think? Though a majority are aware or know they should be, just under half take at least some steps to watch sodium when eating out. Another 53% take no action or say they are not concerned. Q24) Which best describes you most of the time (Select One)

47 Sodium Reduction: What s the best approach? Given the current US marketplace and the resulting excessively high sodium intake, it will be challenging to achieve the lower level. In addition, time is required to adjust taste perception in the general population. Thus, the reduction from 2,300mg to 1,500mg per day should occur gradually over time Dietary Guidelines Advisory Committee Report

48 Sources of Sodium in the Average American Diet SOURCE: Mattes RD, Donnelly D. Relative contributions of dietary sodium sources. J Am Coll Nutr Aug;10(4):

49 The BIG 3: Bread, Meat, Cheese

50 The BIG 3: Bread, Meat, Cheese

51 sodium reduction strategies September 2012

52 Purchasing the Right Ingredients It s not only about what we do, but about what we buy. The very first step we took was to look at our entire menu, ingredient by and ingredient, and see where the biggest sodium offenders were and then began to work with the suppliers of those ingredients to get processed foods with less sodium. It s not enough to have them reduce the sodium, such as in canned tomatoes, we needed better tomatoes, farmed for flavor, canned without the bitter skin and seeds.

53 Flavor development beyond adding sodium will be the primary tool in sodium reduction strategies. Q: Which of the following will your sodium reduction strategy employ or impact? Select all that apply. n= 24

54 The Culinary Institute of America Healthy Menus R&D Collaborative Member Advice on Food & Flavor Employ flavor-building culinary techniques and ideas from various world cuisines. Use the best-quality, high flavor produce available. Use spices, herbs, and other aromatics and a host of healthy sauces & seasonings. Use flavor pairings that heighten and enhance the flavor experience.

55 Culinary Strategies for Reducing Sodium and Enhancing Flavor Avoid aggregating multiple high sodium foods into one dish. Work on the build. Bring in other flavors/products/technique to diminish total sodium. As the Nation is weaned from the excessive taste for salt, entertain the palate. Coax out umami to create deliciousness with less sodium.

56 The Culinary Institute of America Healthy Menus R&D Collaborative Member Success Stories Most are employing a stealth health approach to sodium reduction and balancing flavors Shared Goal: Reducing sodium with no change or minimal change to consumer food experiences or choices. Member Voice: You can t talk about what it doesn't have; you must talk about what it does have.

57 Case Study: American Hero 750 calories, 1450 mg sodium Evaluate Sources of Sodium bread 500mg, meats 500mg cheese 275 Portion Size & Plate Composition Ingredient Sourcing deli turkey & ham vs house roasted/ reduced sodium alternate bread Use of Produce substitute additional vegetables for some of the meat Flavor

58 Questions? 58